Mendlowicz Mauro V, Jean-Louis Girardin, Kelsoe John R, Akiskal Hagop S
Institute of Psychiatry, Federal University of Rio de Janeiro (IPUB-UFRJ), Brazil.
J Affect Disord. 2005 Mar;85(1-2):147-51. doi: 10.1016/j.jad.2004.01.012.
To investigate the presence of temperament dysregulation in healthy relatives of bipolar probands (RBP), a population at high risk for developing mood disorders, by comparing them with clinically recovered bipolar patients (BP) and normal controls (NC).
52 RBP and 23 BP were originally recruited for a multicenter genetic study in bipolar disorders. NC (n=102) were also recruited by newspaper advertisement, radio and television announcements, flyers, newsletters, or word of mouth. All volunteers were asked to complete the TEMPS-A Scale, a self-report questionnaire designed to measure temperamental variations in psychiatric patients and healthy volunteers. In scoring temperaments, we relied upon the short validated version of the TEMPS-A [J. Affect. Disord. (2004)], from which traits with loadings <0.035 had been deleted.
To examine differences in temperament dimensions among the three groups, a MANCOVA model was constructed using diagnostic group as the fixed factor (BP vs. RBP vs. NC); effects of age and gender were adjusted as covariates. MANCOVA showed overall group effect on the dependent variables (Hotelling's F5,175=6.64, p<0.001). Four dependent variables (dysthymic, cyclothymic, irritable, and anxious temperaments) showed significant between-group differences. RBP showed lower cyclothymic temperament scores than BP, but higher scores than NC. BP and RBP showed higher anxious temperament scores than NC. Hyperthymic scores were significantly highest in the NC.
In view of the small cell sizes, bipolar I vs. bipolar II subanalyses could not be conducted.
Methodologic strengths of the present analyses is that the BP group had clinically recovered, and we used the validated short version of the TEMPS-A for the present analyses. Our findings suggest that some clinically healthy relatives of bipolar probands exhibit a subclinical cyclothymic instability in mood, interest, self-confidence, sleep, and/or energy as well as anxiety proneness that is not observed among normal controls. These traits may represent vulnerability markers and could presumably be used to identify individuals at high risk for developing bipolar spectrum disorders, or specific clinical subtypes (e.g., bipolar I, bipolar II) within this spectrum. This is a conceptual perspective with many unanswered questions. Resolution of these questions will require innovative definitions of phenotypes to be included in the analyses of the temperament subscales in different populations. The temperament subscales themselves need to be calibrated properly, to find out which traits or specific combinations of trains are most promising. More extensive and complex quantitative trait analyses of these temperaments in a much expanded sample are reported elsewhere in this issue [J. Affect. Disord. (2004)].
通过将双相情感障碍先证者的健康亲属（RBP，即有患情绪障碍高风险的人群）与临床康复的双相情感障碍患者（BP）及正常对照（NC）进行比较，研究其气质调节异常情况。
最初招募了52名RBP和23名BP用于一项双相情感障碍的多中心基因研究。NC（n = 102）则通过报纸广告、广播电视公告、传单、时事通讯或口口相传的方式招募。所有志愿者都被要求完成TEMPS - A量表，这是一份旨在测量精神科患者和健康志愿者气质变化的自陈问卷。在对气质进行评分时，我们依据的是经过验证的TEMPS - A简版[《情感障碍杂志》（2004年）]，其中载荷<0.035的特质已被删除。
为检验三组之间气质维度的差异，构建了一个以诊断组为固定因素（BP与RBP与NC）的协方差分析模型；年龄和性别的影响作为协变量进行了调整。协方差分析显示，总体组对因变量有影响（Hotelling's F5,175 = 6.64，p < 0.001）。四个因变量（恶劣心境、环性心境、易怒和焦虑气质）显示出显著的组间差异。RBP的环性心境气质得分低于BP，但高于NC。BP和RBP的焦虑气质得分高于NC。轻躁狂得分在NC中显著最高。
鉴于样本量较小，无法进行双相I型与双相II型的亚组分析。
本分析的方法学优势在于BP组已临床康复，且我们在本分析中使用了经过验证的TEMPS - A简版。我们的研究结果表明，一些双相情感障碍先证者的临床健康亲属在情绪、兴趣、自信、睡眠和/或精力方面表现出亚临床的环性心境不稳定以及焦虑倾向，而这在正常对照中未观察到。这些特质可能代表易感性标志物，大概可用于识别有发展为双相谱系障碍高风险的个体，或该谱系内的特定临床亚型（如双相I型、双相II型）。这是一个有许多未解决问题的概念性观点。解决这些问题将需要在不同人群的气质子量表分析中纳入创新的表型定义。气质子量表本身需要进行适当校准，以找出哪些特质或特质的特定组合最有前景。本期其他地方报道了在更大样本中对这些气质进行更广泛、更复杂的数量性状分析[《情感障碍杂志》（2004年）]。
